Does the discrepancy in histologic differentiation between a forceps biopsy and an endoscopic specimen necessitate additional surgery in early gastric cancer?

Table 1 Tumor differentiation between preoperative biopsies and postoperative specimens

After surgery		Before surgery
		Differentiated		Undifferentiated
		WD	MD	PD
Differentiated	WD	56	12	0
	MD	24	45	2
Undifferentiated	PD	4	19	103

PD: Poorly differentiated; MD: Moderately differentiated; WD: Well differentiated.

Table 2 Clinical characteristics of 240 patients and tumor characteristics in 265 specimens n (%)

Variables	Discrepancy	Non-discrepancy	P value
Age (n = 240)
Median, yr (range)	58 (31-83)	61 (35-90)	0.073
Sex (n = 240)
Male	17 (70.8)	147 (68.1)	0.781
Female	7 (29.2)	69 (31.9)
Underlying disease1 (n = 240)
Yes	12 (50.0)	100 (46.3)	0.730
No	12 (50.0)	116 (53.7)
Location (n = 265)
Upper	4 (16.0)	17 (7.1)	0.776
Middle	10 (40.0)	130 (54.2)
Lower	11 (44.0)	93 (38.8)
Gross pattern (n = 265)
Elevated	1 (4.0)	22 (9.2)	0.668
Flat	5 (20.0)	42 (17.5)
Depressed	10 (40.0)	93 (38.8)
Mixed elevated	2 (8.0)	24 (10.0)
Mixed flat	4 (16.0)	31 (12.9)
Mixed depressed	3 (12.0)	28 (11.7)
Ulcer (n = 265)
Positive	12 (48.0)	100 (41.7)	0.542
Negative	13 (52.0)	140 (58.3)
Erythema (n = 265)
Positive	5 (20.0)	52 (21.7)	0.847
Negative	20 (80.0)	188 (78.3)
Fold change (n = 265)
Positive	20 (80.0)	109 (45.4)	0.001
Negative	5 (20.0)	131 (54.9)
Easy friability (n = 265)
Positive	9 (36.0)	84 (35.0)	0.921
Negative	16 (64.0)	156 (65.0)
Exudate (n = 265)
Positive	5 (20.0)	36 (15.0)	0.511
Negative	20 (80.0)	204 (85.0)
Number of biopsies (n = 265)
Median (range)	3 (2-6)	3 (1-10)	0.332
Follow-up period (mo) (n = 240)
Median (range)	41 (2-72)	36 (2-76)	0.629
Recurrences during follow-up (n = 240)	1 (4.2)	2 (0.9)	0.272
Death during follow-up (n = 240)	0 (0.0)	4 (1.9)	1.000

¹Underlying diseases include hypertension, diabetes, and cardiovascular, cerebrovascular, and pulmonary diseases.

Table 3 Histopathological characteristics of surgical specimens n (%)

Variables	Discrepancy	Non-discrepancy	P value
Tumor size in the specimen (n = 265)
Median, cm (range)	3.0 (0.8-5.5)	2.2 (0.4-8.5)	0.252
Tumor staging (n = 265)
Ia	7 (28.0)	121 (50.4)	0.033
Ib	18 (72.0)	119 (49.6)
Nodal staging (n = 265)
Positive	6 (24.0)	19 (7.9)	0.009
Negative	19 (76.0)	221 (92.1)
Lymphatic invasion (n = 265)
Positive	7 (28.0)	41 (17.1)	0.177
Negative	18 (72.0)	199 (82.9)
Vascular invasion (n = 265)
Positive	2 (8.0)	17 (7.1)	0.697
Negative	23 (92.0)	223 (92.9)
Ki-67 (n = 243)
High	20 (95.2)	186 (83.8)	0.215
Low	1 (4.8)	36 (16.2)
p53 (n = 243)
Positive	15 (71.4)	138 (62.2)	0.401
Negative	6 (28.6)	84 (37.8)
HER2 (n = 243)
Positive (2+ and 3+)	7 (33.3)	41 (18.5)	0.102
Negative (0 and 1+)	14 (66.7)	181 (81.5)
EGFR (n = 243)
Positive	17 (81.0)	123 (55.4)	0.035
Negative	4 (19.0)	99 (44.6)

HER2: Human epidermal growth factor 2; EGFR: Epidermal growth factor receptor.

Table 4 Comparison of histopathological characteristics between 23 specimens having discrepancy and 103 specimens having non-discrepancy along with undifferentiated postoperative histology n (%)

Variables	Discrepancy	Non-discrepancy	P value
Tumor size in the specimen (n = 126)
Median, cm (range)	3.0 (0.8-5.5)	2.5 (0.5-8.0)	0.343
Number of biopsies (n = 126)
Median, No. (range)	3 (2-6)	3 (1-8)	0.374
Location (n = 126)
Upper	3 (13.0)	10 (9.7)	0.481
Middle	10 (43.5)	62 (60.2)
Lower	10 (43.5)	31 (30.1)
Gross pattern (n = 126)
Elevated	1 (4.3)	1 (1.0)	0.615
Flat	4 (17.4)	20 (19.4)
Depressed	9 (39.1)	51 (49.5)
Mixed elevated	2 (8.7)	6 (5.8)
Mixed flat	4 (17.4)	16 (15.5)
Mixed depressed	3 (13.0)	9 (8.7)
Tumor staging (n = 126)
Ia	6 (26.1)	52 (50.5)	0.034
Ib	17 (73.9)	51 (49.5)
Nodal staging (n = 126)
Positive	6 (26.1)	9 (8.7)	0.020
Negative	17 (73.9)	94 (91.3)
Lymphatic invasion (n = 126)
Positive	7 (30.4)	12 (11.7)	0.023
Negative	16 (69.6)	91 (88.3)
Vascular invasion (n = 126)
Positive	2 (8.7)	2 (1.9)	0.152
Negative	21 (91.3)	101 (98.1)
Ki-67 (n=120)
High	48 (94.7)	77 (76.2)	0.119
Low	1 (5.3)	24 (23.8)
p53 (n = 120)
Positive	13 (68.4)	59 (58.4)	0.414
Negative	6 (31.6)	42 (41.6)
HER2 (n = 120)
Positive (2+ and 3+)	7 (36.8)	16 (15.8)	0.033
Negative (0 and 1+)	12 (63.2)	85 (84.2)
EGFR (n = 120)
Positive	16 (84.2)	52 (51.5)	0.011
Negative	3 (15.8)	49 (48.5)

HER2: Human epidermal growth factor 2; EGFR: Epidermal growth factor receptor.